Evidence map›Paper›PMID 30578828›Full record

ArticleSeminars in thoracic and cardiovascular surgery2019

First Reported Use of Team Cognitive Workload for Root Cause Analysis in Cardiac Surgery.

Marco A Zenati, Kay B Leissner, Suzana Zorca, Lauren Kennedy-Metz, Steven J Yule, Roger D Dias

Open access · greenAbstract read
In one paragraph

Article in Seminars in thoracic and cardiovascular surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed
2.4field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 34 citations in OpenAlex.

  1. Observational
  2. Article
  3. Review
  4. Review
  5. Exploring Intraoperative Cognitive Biases in Cardiac Surgery Teams.Applied Human Factors and Ergonomics Conference · 2024
    Article
  6. Article
  7. Review
  8. Association Between Operating Room Noise and Team Cognitive Workload in Cardiac Surgery.IEEE Conference on Cognitive and Computational Aspects of Situation Management (CogSIMA) · 2022
    Article
  9. Article
  10. Towards an AI Coach to Infer Team Mental Model Alignment in Healthcare.IEEE Conference on Cognitive and Computational Aspects of Situation Management (CogSIMA) · 2021
    Article
  11. The Cognitive Relevance of a Formal Pre-incision Time-out in Surgery.ECCE ... : proceedings of the ... European Conference on Cognitive Ergonomics. European Conference on Cognitive Ergonomics · 2021
    Article
  12. Observational
  13. Article
  14. Article
  15. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Marco A ZenatiDivison of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Medical Robotics and Computer-Assisted Surgery (MRCAS) Laboratory, Boston, Massachusetts. Electronic address: Marco_Zenati@hms.harvard.edu.
Kay B LeissnerDepartment of Anesthesiology and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
Suzana ZorcaDepartment of Anesthesiology and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
Lauren Kennedy-MetzMedical Robotics and Computer-Assisted Surgery (MRCAS) Laboratory, Boston, Massachusetts.
Steven J YuleDepartment of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; STRATUS Simulation Center, Brigham & Women's Hospital, Boston, Massachusetts.
Roger D DiasSTRATUS Simulation Center, Brigham & Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Brigham & Women's Hospital, Boston, Massachusetts.
Brigham and Women's Hospital · USVA Boston Healthcare System · US

Funding

Developing Standardized Intraoperative Process Models to Enhance Surgical SafetyR01HL126896 · NHLBI · HARVARD MEDICAL SCHOOL · PI ZENATI, MARCO A. · 2016 to 2023
$3.7M
NHLBI NIH HHS R01 HL126896
6 · The paper itself

Abstract

Cognitive workload data of members of the cardiac surgery team can be measured intraoperatively and stored for later analysis. We present a case of a near-miss (medication error) that underwent root cause analysis using workload data. Heart rate variability data, representing workload levels, were collected from the attending surgeon, attending anesthesiologist, and lead perfusionist using wireless heart rate monitors. An episode of cognitive overload of the anesthesiologist due to a distractor was associated with the preventable error. Additional studies are needed to better understand the role of psychophysiological data in enhancing surgical patient safety.

Indexed as

CognitionNear Miss, HealthcarePatient Care TeamWorkloadAdministration, IntravenousAnesthetistsClinical CompetenceCoronary Artery BypassHeart RateHeparin AntagonistsHumansMedication ErrorsProtaminesRisk AssessmentRisk FactorsRoot Cause AnalysisHeparin AntagonistsProtaminesCardiac surgeryCognitive workloadHeart rate variabilityRoot cause analysisTeam workload

Identifiers

PMID30578828
PMCPMC6584063
OpenAlexW2905209797

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.